Discrepancy in the Distribution Patterns of Subchondral Bone Density Across the Ankle Joint After Medial Opening-Wedge and Lateral Closing-Wedge High Tibial Osteotomy

Background: High tibial osteotomy (HTO) changes the alignment and dynamics of the ankle joint; however, differences in the stress distribution of the ankle joint after opening-wedge HTO (OWHTO) and closing-wedge HTO (CWHTO) are not understood. It is believed that subchondral bone density of the articular surface reflects the pattern of cumulative stress distribution across the joint surface. Purpose: To clarify the effects of OWHTO and CWHTO on the distribution patterns of subchondral bone density across the ankle joint using computed tomography (CT)–osteoabsorptiometry. Study Design: Cohort study; Level of evidence, 4. Methods: Radiographic and CT data of 18 cases who underwent OWHTO (OW group), 12 cases who underwent CWHTO (CW group), and 11 cases with unilateral anterior cruciate ligament injury serving as controls were retrospectively reviewed. The subchondral bone density of the distal tibia was assessed in the 3 groups using CT-osteoabsorptiometry. The distal tibial surface of the ankle joint was divided into 4 parts in the coronal direction, and the percentage of the high-density area (%HDA) to each subregion was compared before and after HTO. Results: Preoperatively, comparing %HDA among the 3 groups, there were no significant differences in any regions. In the OW group, postoperative %HDA in the most medial region was significantly increased compared with preoperative %HDA (49.3% to 53.0%; P = .011), and postoperative %HDA in the most lateral region was significantly decreased (21.4% to 17.2%; P = .003). On the other hand, in the CW group, postoperative %HDA in the most medial region was significantly decreased (55.7% to 35.7%; P = .001), and %HDA in the second lateral region was significantly increased (23.6% to 29.2%; P = .002). Conclusion: The ankle distribution pattern of subchondral bone density shifted significantly medially after OWHTO without fibular osteotomy, whereas the distribution pattern shifted laterally after CWHTO with fibular osteotomy. When the OWHTO is performed for patients with medial ankle osteoarthritis, surgeons should pay attention to potential postoperative progression of ankle osteoarthritis due to medial shift of the stress distribution in the ankle joint.

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Long-term Stress Distribution Patterns Across the Ankle Joint in Soccer Players: A Computed Tomography Osteoabsorptiometry Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120963085 ◽

2020 ◽

Vol 8 (11) ◽

pp. 232596712096308

Author(s):

Junki Shiota ◽

Daisuke Momma ◽

Takayoshi Yamaguchi ◽

Norimasa Iwasaki

Keyword(s):

Bone Density ◽

Stress Distribution ◽

Ankle Joint ◽

Subchondral Bone ◽

Articular Surface ◽

Distribution Patterns ◽

High Density ◽

Soccer Players ◽

Subchondral Bone Density

Background: The distribution pattern of subchondral bone density is considered to accurately reflect the stress distribution over a joint under long-term physiologic loading. The biomechanical characteristics of the surface of the ankle joint in soccer players can be determined by measuring this distribution pattern under long-term loading. Purpose: To evaluate the distribution of subchondral bone density across the ankle joint in soccer players and to determine the effects of soccer activities, including kicking motion, on the ankle joint surface under long-term loading conditions by computed tomography (CT) osteoabsorptiometry (CTOAM). Study Design: Cross-sectional study; Level of evidence, 3. Methods: CT imaging data were obtained from both ankles of 10 soccer players (soccer group) and 10 nonathletic volunteers (control group). The distribution patterns of subchondral bone density across the articular surface of the ankle joints were assessed by CTOAM. Quantitative analysis was performed of the locations and percentages of high-density areas on the articular surface. Results: Stress distribution patterns over the ankle joint differed between the soccer players and controls. In the soccer players, the high-density areas were found in the anterior part of the distal tibia and proximal talus as well as the distal fibula. The percentages of high-density areas were greater in the soccer players compared with controls ( P < .0001). Conclusion: Stress distribution over the articular surface of the ankle joint was affected by soccer activities. A high stress concentration was seen in soccer players in the anterior part of the tibia and talus and in the fibula; such excessive stress may lead to anterior impingement.

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Effect of High Tibial Osteotomy on the Distribution of Subchondral Bone Density Across the Proximal Tibial Articular Surface of the Knee With Medial Compartment Osteoarthritis

The American Journal of Sports Medicine ◽

10.1177/03635465211002537 ◽

2021 ◽

pp. 036354652110025

Author(s):

Koji Iwasaki ◽

Eiji Kondo ◽

Shinji Matsubara ◽

Masatake Matsuoka ◽

Kaori Endo ◽

...

Keyword(s):

Bone Density ◽

Stress Distribution ◽

Subchondral Bone ◽

Proximal Tibia ◽

Articular Surface ◽

Medial Compartment ◽

Control Group ◽

Tibial Osteotomy ◽

Subchondral Bone Density ◽

Hip Knee Ankle Angle

Background: The effect of high tibial osteotomy (HTO) on the stress distribution across the knee joint is not completely understood. Subchondral bone density is considered to reflect the pattern of stress distribution across a joint surface. Purpose: To assess the distribution of subchondral bone density across the proximal tibia in nonarthritic knees and in the knees of patients with osteoarthritis (OA) before and after HTO. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively collected radiological and computed tomography data from 16 patients without OA (control group) and 17 patients with OA. Data from the OA group were collected before and 1.5 years after HTO. Subchondral bone density of the proximal tibia was assessed with computed tomography–osteoabsorptiometry. The locations and percentages represented by high-density areas (HDAs) on the articular surface were quantitatively analyzed. Results: The ratio of the HDA of the medial compartment to the total HDA (medial ratio) was significantly higher in the preoperative OA group (mean, 80.1%) than in the control group (61.3%) ( P < .001). After HTO, the medial ratio decreased significantly to 75.1% ( P = .035 in comparison with preoperative values) and was significantly correlated with the hip-knee-ankle angle in both groups: control ( r = −0.551; P = .033) and OA ( r = −0.528; P = .043). The change in medial ratio after HTO was significantly correlated with the change in hip-knee-ankle angle ( r = 0.587; P = .035). In the medial compartment, the HDA in the most lateral region of 4 subregions increased after HTO, but that in 3 medial subregions decreased. Conclusion: In this exploratory study, HTO shifted the HDA of the medial compartment of the proximal tibial articular surface toward the lateral compartment. In contrast, the HDA of the most lateral region of the medial compartment increased after HTO. This change in subchondral bone density may result from the change in stress distribution.

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Stress Distribution Patterns Across the Shoulder Joint in Gymnasts: A Computed Tomography Osteoabsorptiometry Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120962103 ◽

2020 ◽

Vol 8 (11) ◽

pp. 232596712096210

Author(s):

Daisuke Momma ◽

Wataru Iwamoto ◽

Kaori Endo ◽

Kazuki Sato ◽

Norimasa Iwasaki

Keyword(s):

Bone Density ◽

Stress Distribution ◽

Distribution Pattern ◽

Subchondral Bone ◽

Shoulder Joint ◽

Glenohumeral Joint ◽

Articular Surface ◽

Articular Surfaces ◽

Subchondral Bone Density ◽

Collegiate Gymnasts

Background: The distribution pattern of subchondral bone density is an indicator of stress distribution over a joint surface under long-term physiologic loading. The biomechanical characteristics of the articular surfaces of the shoulder joint in gymnasts can be determined by measuring this distribution pattern. Purpose: To evaluate the distribution of subchondral bone density across the shoulder joint in male collegiate gymnasts and to determine the effects of gymnastic activities on its articular surfaces under long-term loading conditions using computed tomography osteoabsorptiometry (CTOAM). Study Design: Descriptive laboratory study. Methods: CT image data were obtained from both shoulders of 12 asymptomatic male collegiate gymnasts (gymnast group; mean age, 19.4 years; range, 18-22 years) and 10 male collegiate volunteers (control group; mean age, 20.2 years; range, 18-22 years). The distribution pattern of subchondral bone density across the articular surfaces of each shoulder joint was assessed by CTOAM. Quantitative analysis was performed of the locations and percentages of high-density areas on the articular surface. Results: Stress distribution patterns over the articular surfaces differed between the gymnasts and the controls. In the gymnasts, high-density areas were detected on the posterosuperior articular surface of the humeral head and the anterosuperior and/or posterosuperior articular surface of the glenoid. Mean bone density was greater in the gymnasts than in the controls ( P < .0001). Conclusion: Stress distribution over the articular surfaces of the shoulder joint was affected by gymnastic activities. Stress was concentrated over the superior part of the glenohumeral joint in male collegiate gymnasts. Clinical Relevance: The present findings suggest that gymnastic activities increase stress to the articular surfaces of the superior glenohumeral joint. This supports the notion that mechanical conditions play a crucial role in the origin of disorders particular to gymnastic activities.

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Stress-Distribution Pattern Across the Glenohumeral Joint in Collegiate and Professional Baseball Players: A Computed Tomography Osteoabsorptiometry Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211009185 ◽

2021 ◽

Vol 9 (6) ◽

pp. 232596712110091

Author(s):

Kyosuke Numaguchi ◽

Daisuke Momma ◽

Yuki Matsui ◽

Masashi Yokota ◽

Jun Oohinata ◽

...

Keyword(s):

Bone Density ◽

Stress Distribution ◽

Glenohumeral Joint ◽

Distribution Patterns ◽

Joint Surface ◽

Baseball Players ◽

Articular Surfaces ◽

Head Surface ◽

The Mean ◽

Dominant Side

Background: The influence of long-term loading conditions on the articular surfaces of the glenohumeral joint can be determined by measuring stress-distribution patterns. Long-term pitching activity changes the stress distribution across the glenohumeral joint surface; however, the influence of competitive level on stress-distribution patterns remains unclear. Purpose: To use computed tomography (CT) osteoabsorptiometry (CTOAM) to evaluate the distribution of subchondral bone density across the glenohumeral joint in collegiate and professional baseball players as well as to determine the effects of pitching activity on the articular surfaces. Study Design: Descriptive laboratory study. Methods: We evaluated 73 shoulders in 50 baseball players. CT imaging data were obtained from the dominant-side shoulder of 12 professional pitchers (PP group) and 15 professional fielders (PF group). CT imaging data were also obtained from both shoulders of 12 asymptomatic collegiate pitchers (CP group) and 11 collegiate fielders (CF group). The pattern of distribution of subchondral bone density across the articular surfaces of each glenohumeral joint was assessed by CTOAM. As a measure of bone density, the mean Hounsfield units (HU) were obtained for each joint surface, and the absolute values of the dominant shoulder were compared for each group. Results: Stress-distribution patterns over the articular surfaces differed between the dominant and nondominant sides in the CP group as well as between both collegiate groups versus the PP group. In the CP group, the mean HU of the humeral head surface were greater on the nondominant versus dominant side ( P = .035). On the dominant side, the mean HU of the humeral head surface and glenoid were greater in the CP versus the PP group ( P = .001 and .027, respectively). Conclusion: Stress distribution on the articular surface of the glenohumeral joint was affected by pitching ability and competitive level. Our analysis indicates that the traction force on the glenohumeral joint surface might be greater than compression force during pitching. Clinical Relevance: The present findings suggest that pitching activity results in low stress to the articular surfaces of the glenohumeral joint. This supports the notion that mechanical conditions play a crucial role in the etiology of disorders specific to pitching activity.

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Realignment Surgery for Anterior Translation of Talus after Malunited Ankle Fracture

10.21203/rs.2.12098/v1 ◽

2019 ◽

Author(s):

Xingchen Li ◽

Kai Rong ◽

Yang Xu ◽

Yuan Zhu ◽

Xiangyang Xu

Keyword(s):

Soft Tissue ◽

Ankle Joint ◽

Ankle Fracture ◽

Sagittal Plane ◽

Tibial Osteotomy ◽

Ankle Osteoarthritis ◽

Anterior Translation ◽

Functional Scores ◽

Weber Type ◽

The Mean

Abstract Background: It is challenging for the clinical management of malunited ankle fracture. The aim of this study is to evaluate the clinical outcome of realignment surgery for anterior translation of talus after malunited ankle fracture and to analyze its. Methods: A total of 11 patients with anterior translation of talus after malunited ankle fractures underwent corrective osteotomy in our institute were retrospectively reviewed. All patients were evaluated with radiological parameters and clinical functional scores. There were 4 patients with Weber type A fracture, 4 patients with Pilon type B fracture and 3 patients with Weber type C fracture. 8/11 patients had impaction on the anterior distal tibial plafond, intra-articular distal tibial osteotomy was performed in these patients, additional bony correction and soft tissue surgery were also performed to achieve congruent ankle joint. Results: The mean age at surgery was 32.8 ± 10.8 (range,16-48) years. The mean follow-up time was 50.5 ± 23.6 (range, 16-80) months. The mean AOFAS-AH score increased from 28.2 ± 19.1preoperatively to 72.5 ± 8.1 points postoperatively(p<0.05), the mean lateral talar station(LTS) improved from 9.2 ± 3.7 preoperatively to 1.5 ± 1.4 mm postoperatively(p<0.05). 10/11 patients had improvement or no worsening ankle osteoarthritis on sagittal plane, while 1 patient had advanced ankle osteoarthritis. Conclusion: A congruent ankle joint in sagittal plane could be achieved by corrective osteotomies with additional soft tissue procedures. The realignment surgery was a valuable treatment option for the salvage of anterior translation of talus after malunited ankle fracture.

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Long-term effects of tibial plateau leveling osteotomy and tibial tuberosity advancement on tibial plateau subchondral bone density in dogs

Veterinary Surgery ◽

10.1111/vsu.12790 ◽

2018 ◽

Vol 47 (4) ◽

pp. 566-571 ◽

Cited By ~ 2

Author(s):

Elizabeth S. Leach ◽

Ursula Krotscheck ◽

Kelsey J. Goode ◽

Galina M. Hayes ◽

Peter Böttcher

Keyword(s):

Bone Density ◽

Subchondral Bone ◽

Tibial Plateau ◽

Tibial Tuberosity ◽

Long Term Effects ◽

Subchondral Bone Density

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Spatial Subchondral Bone Density Reflecting Joint Loading of the Talus in Different Canidae

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0039-1685511 ◽

2019 ◽

Vol 32 (03) ◽

pp. 207-214

Author(s):

Walter Dingemanse ◽

Ingrid Gielen ◽

Henri van Bree ◽

Magdalena Müller-Gerbl ◽

Nikola Krstić ◽

...

Keyword(s):

Bone Density ◽

Density Distribution ◽

Subchondral Bone ◽

Canis Lupus ◽

Joint Loading ◽

German Shepherd ◽

Canis Aureus ◽

Joint Biomechanics ◽

Subchondral Bone Density

Objective Subchondral bone density distribution can be used to study joint biomechanics non-invasively. Differences in joint loading between related species can aid in the understanding of joint loading and the development of certain types of orthopaedic pathology. This study was conducted to evaluate density distribution in the subchondral bone of the talus of different Canidae species, as a parameter reflecting the long-term joint loading in the tarsocrural joint. Materials and Methods The tarsal joints of cadaveric dogs of different breeds were included, that is, German Shepherd (n = 5), Bouvier des Flandres (n = 3) and Labrador Retriever (n = 6).Additionally, golden jackals (n = 5) (Canis aureus) and wolves (n = 5) (Canis lupus) were included. Consecutive computed tomography slices were made and the subchondral bone density distribution was evaluated using computer tomographic osteoabsorptiometry. Different breeds and species were visually compared. Results Differences were found in the subchondral bone density distribution of the talus between breeds and between species (Canis familiaris, Canis lupus and Canis aureus). Discussion and Conclusion Based on the density distribution, there are differences in loading conditions of the tarsocrural joint in different species of Canidae. The joint loading distribution is very similar between dogs of the same breed and within the same species. Although between-breed differences can be explained by conformational differences, the between-species differences remain subject to further research.

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Lumbar facet joint subchondral bone density in low back pain and asymptomatic subjects

Skeletal Radiology ◽

10.1007/s00256-019-03314-w ◽

2019 ◽

Vol 49 (4) ◽

pp. 571-576

Author(s):

Chien-Chou Pan ◽

Peter Simon ◽

Alejandro A. Espinoza Orías ◽

Ryota Takatori ◽

Howard S. An ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Bone Density ◽

Subchondral Bone ◽

Facet Joint ◽

Low Back ◽

Lumbar Facet Joint ◽

Subchondral Bone Density ◽

Asymptomatic Subjects ◽

Lumbar Facet

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20 Degree Post Traumatic Ankle Valgus and Distal Lateral Tibial Osteonecrosis Treated with Staged Deformity Correction and Total Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000159 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Lawrence DiDomenico ◽

Danielle Butto

Keyword(s):

Ankle Joint ◽

Deformity Correction ◽

Total Ankle Arthroplasty ◽

Wedge Osteotomy ◽

Tibial Osteotomy ◽

Opening Wedge ◽

Ankle Arthroplasty ◽

Initial Surgery ◽

Post Traumatic ◽

Ankle Valgus

Category: Ankle, Ankle Arthritis Introduction/Purpose: The purpose of this review is to present a case of post-traumatic ankle valgus and distal lateral tibial osteonecrosis successfully treated with staged deltoid repair, opening wedge tibial osteotomy, fibular lengthening, syndesmotic fusion and total ankle arthroplasty. Methods: Initial surgery consisted of ankle joint arthrotomy and deltoid imbrication. The second surgery consisted of a tibial opening wedge osteotomy with autogenous cortical fibular bone graft superior to the area of osteonecrosis to correct the 20 degree ankle valgus. Fibular lengthening osteotomy and fusion of the distal syndesmosis were also performed. CT scan confirmed bony consolidation at the distal tibiofibular syndesmosis as well as union of the allograft opening wedge. The final surgery was total ankle joint replacement with bone grafting of the area of osteonecrosis. Results: After 5 years of follow up the patient has progressed out of his AFO to full weightbearing. He reports no ankle pain, improved function and range of motion and is ambulating independently with no assistive devices. Conclusion: We successfully treated a case of distal lateral tibial osteonecrosis, and a 20 degree ankle valgus with staged deformity correction and ankle replacement. Radiographs demonstrate a well seated and positioned implant. We believe that with proper alignment that total ankle arthroplasty is a safe treatment option in the face of bone infarction.

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